Nurses were burning out before COVID-19. Long hours, intense emotions and cumbersome procedures all generate stress.
The pandemic made a bad situation worse, according to research from an unusual source: freshly minted doctoral degree recipient Lynne Moronski.
Unlike most doctoral students, who enroll shortly after undergraduate work, Moronski first spent 25 years raising a family and rising through the administration at Memorial Sloan Kettering Cancer Center. She then got an undergraduate nursing degree and worked at Horizon Blue Cross Blue Shield before seeking the Ph.D. from the Rutgers School of Nursing.
Having just received her doctor of philosophy from Rutgers, Moronski is starting a new career – as a postdoctoral fellow at the University of Pennsylvania’s nursing school – that draws both from her time at Rutgers and her previous experience.
What are the main findings of your dissertation?
That the pre-existing issue of nurse burnout worsened during the Covid pandemic. More than 100,000 nurses left the workforce during COVID, the worst exodus in our lifetime. My dissertation surveyed 856 nurses working at acute care hospitals in New Jersey to determine why.
What did they tell you?
The information they provided was concerning. Sixty-four percent were experiencing occupational burnout, 51 percent screened positive for symptoms of post-traumatic stress disorder, 51 percent reported dissatisfaction with their current jobs, and 42 percent reported plans to leave their current jobs.
What caused these problems?
Patient workloads, nonsupportive work environments, the COVID pandemic’s negative psychological impact and longer work shifts were all associated with job dissatisfaction and intent to leave.
Longer shifts?
Yes, that was an unexpected finding. Nurses who worked 12-hour shifts reported significantly more job dissatisfaction than those who worked eight-hour shifts. The longer shifts became the standard in the United States after World War II because they reduced patient handoffs. Nurses typically support 12-hour shifts for all the extra days off, but they’re very unhealthy.
How did you come to this research?
Via a long path that began in 1994 when I took my first post-college job at Sloan Kettering. I started as a liaison between patients and physicians, branched out into disease management and eventually moved into clinical informatics and the transition from paper to electronic. My other roles there involved project management, senior system analyst and more, with time off to raise children and earn a master’s in public administration.
When did you make the jump to nursing?
I got my first nursing degree from Rutgers in 2018 with plans to do clinical practice, but I could only find overnight shifts, and given my age and health, I didn't feel that that was the right move for me.
I became a case manager at Horizon, which was a perfect blend of troubleshooting and clinical knowledge. I had a wonderful time there for a year and a half until my mentor Linda Flynn, dean and professor at Rutgers School of Nursing, convinced me to come back to Rutgers.
How has your previous work affected your doctoral research?
There’s a big advantage to having broad experience with clinical practice. You can read all you want about how things work, but you don’t really know till you’ve been there, and I’ve been there. I’ve spent decades working with nurses, and I hope that will inform my work and increase its practical impact.
How can we fix our issues with nursing burnout and shortages?
Nurse satisfaction varies greatly from the best-run facilities to the worst, as does nurse retention, so we know the problem can be solved or at least greatly reduced.
Facilities need to poll their nurses and fix the problems that create dissatisfaction. I’d also advocate allowing people to work a variety of shift lengths – even though that can create scheduling headaches – and providing far more mental wellness services. As word gets around that conditions have improved, nurses will return to the profession. It has happened before.
